Medical Ethics

This paper critically evaluates current conceptions of pregnancy as a possession of either mother or infant. In opposition to the more common stance that marks birth as the beginning of intercorporeality and perception, pregnancy is instead phenomenologically delineated as a chiasmic relationship between mother and her pre‐infant from a Merleau‐Pontian perspective. This paper maintains that during pregnancy a mother‐to‐be and her pre‐infant are deepened and modified through their intertwining.

There has recently been some literature on the properties of a Health-Related Social Welfare Function (HRSWF). The aim of this article is to contribute to the analysis of the different properties of a HRSWF, paying particular attention to the monotonicity principle. For monotonicity to be fulfilled, any increase in individual health—other things equal—should result in an increase in social welfare. We elicit public preferences concerning trade-offs between the total level of health (concern for efficiency) and its distribution (concern for equality), (...) under different hypothetical scenarios through face-to-face interviews. Of key interests are: the distinction between non-monotonic preferences and Rawlsian preferences; symmetry of HRSWF; and the extent of inequality neutral preferences. The results indicate strong support for non-monotonic preferences, over Rawlsian preferences. Furthermore, the majority of those surveyed had preferences that were consistent with a symmetric and inequality averse HRSWF. (shrink)

For a long time the Western world was in a state of denial about the human body. There were conventions governing its representation and it could be regarded as an element of discourse. Between 1636 and 1638, Peter Paul Rubens painted a portrait of his second wife, Helena Fourment, entitled The little fur. This may be a turning-point in the perception of the body. We see in this work that the skin of this 22-year-old woman has lost its elasticity, her (...) breasts are not symmetrical and her ankles are pink, contrasting with the pearly white of the rest of her body. The inside of her left thigh shows signs of a varicose saphenous vein. While today’s doctors can suggest the possibility of venous insufficiency and benign familial hyperelasticity, and talk of the consequences of breast-feeding, what this canvas is doing above all is showing the body of a real, named individual, “warts and all”. This may be one of the first portraits of a body in the history of European painting. (shrink)

Medical doctors appear in numerous Rembrandt paintings and reciprocally, physicians interested in art have used their diagnostic skills in dissecting the painter’s work, especially his lifetime of self-portraits. The possible existence of skin and eye diseases, hypothyroidism and Horton’s disease, and psychiatric and psychological traits has been a matter of everlasting debate, as summarised in the present paper. Most of all, the ageing process reveals itself over time in the continuity of the self-portraits. In the quest for signs of illness, (...) the slightest bump in the canvas can be considered a symptom, and the examination of Rembrandt’s self-portraits is a difficult exercise. However, the resulting published papers have given rise to a great number of diagnostic hypotheses. (shrink)

Peaceful protests and strikes are a basic human right as stated in the United Nations’ universal declaration on human rights. But for doctors, their proximity to life and death and the social contract between a doctor and a patient are stated as the reasons why doctors are valued more than the ordinary beings. In Pakistan, strikes by doctors were carried out to protest against lack of service structure, security and low pay. This paper discusses the moral and ethical concerns pertaining (...) to the strikes by medical doctors in the context of Pakistan. The author has carefully tried to balance the discussion about moral repercussions of strikes on patients versus the circumstances of doctors working in public sector hospitals of a developing country that may lead to strikes. (shrink)

This qualitative research used the perspective and hermeneutic process of continental philosopher Paul Ricoeur. The question, what is the person's self understanding of personal identity amidst loss?, was an attempt to understand the lived experience of loss as explicated in a loss narrative. The researcher was also interested in the characteristics of a loss narrative. Although loss and grief are linked in the literature, the researcher posits two distinct phenomenon. ;Ricoeur provided a framework to explain how loss becomes an impediment (...) to self-understanding. The person in a state of loss experiences his or her self in a disrupted state of self-understanding. The "who" and "what" of personal-identity engages in a tensive dialectic for self-interpretation and self-understanding. ;The notion of loss is also a rupture to one's ordinary experience of time. The rupture to self-understanding is reflected in the dialectic with self, before and after the loss. The tensive dialectic unfolds in the discourse on loss through time. The perspective of Ricoeur recognizes the dialectic of self unfolding in the lived experience while reflecting on the past and considering future possibilities. ;The participant and the nurse-interviewer each engaged in a dialogue through his or her hermeneutic process of self-understanding. The researcher entered into the hermeneutic circle of the text of the interview. The researcher asked one question, Can you tell a story about the personal meaning of loss? The story of loss was historically and contextually situated. The nurse-interviewer intervened for clarification purposes. ;The phenomenon of loss was identified as a hermeneutical process of self-understanding. In the process, a genre of loss narrative was identified, based on ten common characteristics: identification of loss, physical expressions/experiences of the loss, physical representations that lingered, objectively and symbolically, undergoing and enduring loss, linkages with other losses, communal or relational characteristic, anticipated loss, the larger schema, discovering, and temporality. These formed the components of the personal meaning of loss within the hermeneutic process of self-understanding recounted in the narratives. ;The characteristic of temporality explicated the phenomenon further. Temporality reflected a dialectic between cosmological time and phenomenal time, provisional nature of the narrative, self-interpretative process in time with conflicting self-interpretations, and reconstruction in the self interpretative process, temporal definition of a larger schema, and the way time provided the style to the narrative. ;Using the Ricoeurian principle of distanciation, the nurse-researcher recognizes many opportunities for nursing and future research: understanding a phenomenon as a hermeneutic enables nursing to listen in a unique manner, the notion of provisional temporality can assist nursing create ways that the person can deepen and expand one's personal identity in the self-reflective process, nursing can understand the "work" of nursing as a hermeneutic process itself where healing unfolds in the every day discourse of life, enhancing understanding of aging and retirement as aspects of loss and the relationship to personal-identity. (shrink)

Breaking bad news to mothers whose children has disability is an important role of physicians. There has been considerable speculation about the inevitability of parental dissatisfaction with how they are informed of their child’s disability. Egyptian mothers’ preferences for how to be told the bad news about their child’s disability has not been investigated adequately. The objective of this study was to elicit Egyptian mothers’ preferences for how to be told the bad news about their child’s disability.

The American Journal of Bioethics, Volume 12, Issue 9, Page 26-28, September 2012.

Recently, moral deliberation within care institutions is gaining more attention in medical ethics. Ongoing dialogues about ethical issues are considered as a vehicle for quality improvement of health care practices. The rise of ethical conversation methods can be understood against the broader development within medical ethics in which interaction and dialogue are seen as alternatives for both theoretical or individual reflection on ethical questions. In other disciplines, intersubjectivity is also seen as a way to handle practical problems, and methodologies have (...) emerged to deal with dynamic processes of practice improvement. An example is responsive evaluation. In this article we investigate the relationship between moral deliberation and responsive evaluation, describe their common basis in dialogical ethics and pragmatic hermeneutics, and explore the relevance of both for improving the quality of care. The synergy between the approaches is illustrated by a case example in which both play a distinct and complementary role. It concerns the implementation of quality criteria for coercion in Dutch psychiatry. (shrink)

Ethics issues in the areas of science, technology and medicine have emerged during the last few decades. Many countries have responded by establishing ethics committees at the national level. Identification of National Ethics Committees (NECs) in the Eastern Mediterranean (EM) region and the extent of their functions and capacity would be helpful in developing capacity building programs that address the needs of these committees. Accordingly, we conducted a survey to determine the characteristics of existing NECs in the EM region.

A collection of dramatic accounts about doctors who have faced the moral dilemma of choosing between obeying rules and doing what is best for a patient offers insight into the essential principles of medical ethics and their impact on ...

How one goes about teaching medical ethics greatly depends upon one's interpretation of the discipline itself. Before discussing pedagogical isslIes, the primary focus ofthe paper, I will address the question of what "philosophical" medical ethics is and is not. I will then suggest some alternative approac:hes forincluding such material in a variety of different contexts, including courses geared toward philosophy students, those focusing on undergraduate students preparing for careers in one of the health care professions, and those actually within professional (...) schools, primarily medical schools, with which I am mostfamiliar. I will end with remarks on the implications of medical etllics for medicine and for philosophy. (shrink)

"In this article, I argue that under current resource constraints, institutional arrangements seeking to ensure commonly accepted egalitarian goals would engender the decrease of health status of many who do not currently enjoy particularly high levels of health.".

My little girl has leukemia; she has had it for over a year, and now she needs at least five pints of blood a day. Not the whole blood, just the platelets. Most of our relatives and friends have given at least a few times. But we need more. Now I have to go to strangers.So begins Roberta Silman's short story, “Giving Blood,” a story about illness and charity. When the narrator's husband solicited blood donations at his workplace, “he thought (...) everyone would help…He must have asked a hundred people. Thirty gave. His officemate…turned green and said, ‘Oh, no, anything but that. I'm scared of needles.'”. (shrink)

This article deals both with greatly extended finite life and with immortality and uses the term ‘greatly extended life’ to cover both. Except where indicated, it proceeds from some assumptions adapted from Christine Overall. First, people would know the life expectancy in their society or would know that they were immortal. Second, everyone would have the opportunity to choose greatly extended life. Third, greatly extended life would not be mandatory; people would be able to opt out at any point.

In response to national trends calling for increasing accountability and an emerging dialogue within bioethics, we describe an effort to credential clinical ethicists at a major academic medical center. This effort is placed within the historical context of prior calls for credentialing and certification and efforts currently underway within organized bioethics to engage this issue. The specific details, and conceptual rationale, behind the New York-Presbyterian Hospital’s graduated credentialing plan are shared as is their evolution and ratification within the context of (...) institutional policy. While other programs will design their credentialing schema consistent with their local context and demographics, the description of one such effort is offered to be instructive to others who want to bring additional standardization to the assessment of the readiness and credentials of those who will engage in the practice of clinical ethics case consultation. (shrink)

Medical humanities—history, literature, anthropology, ethics and fine arts applied to medicine—play an important role in medical education. For more than 20 years an effort has been made to obtain an academic identity for such a multidisciplinary approach. A distinction between humanitarianism and humanism is attempted here, the former being associated with medical care and the latter with medical education. In order more precisely to define the relationship between the arts and medicine, an alternative term “medical kalology”, as-yet-unsanctioned, coined after the (...) rules of medical terminology, is proposed. The Department of Medical Humanities in the School of Medicine, National University of La Plata, submits the following apologia: Don't cry for us Argentinians, since the teaching of medical humanities has helped our doctors to function more truly humanistically during the past two decades, and we intend to continue with this calling in the future. (shrink)